Does sleep myoclonus need treatment?

We all know that newborn babies will make some movements unconsciously, and they will often move even when they are sleeping. Parents should pay attention if their baby exhibits high-frequency and large-amplitude movements. Sleep myoclonus is a type of epilepsy with a special form of spasm that is more common in infancy and childhood. There are many causes of sleep myoclonus, most of which are caused by the brain. This disease should be detected and treated early, so how should it be treated?

Clinical manifestations

Myoclonus (1) Bowing spasm: It is characterized by a sudden onset of brief whole-body muscle spasm, with the neck, trunk and legs flexed, adducted or abducted, and the arms stretched forward and outward in a hugging position;

(2) Nodding spasms: Nodding spasms occur;

(3) Lightning spasm: It lasts for a very short time and is difficult to detect if you don’t pay attention.

Patients with myoclonic epilepsy may experience sudden single twitches of the head, neck, limbs, or trunk muscles, sometimes only one muscle or certain muscle groups twitching. The twitch is followed by immediate relaxation, which can be on one or both sides. Mild myoclonus may affect only the head or hands. Twitching of the upper limbs may cause objects in the hands to be dropped or thrown. In more serious cases, the whole body is affected and the person may suddenly lose balance and fall while standing. When sitting, you can jump out from your seat. Therefore, this type of patients often have scars on the forehead, nose tip, lips, etc. Usually, the attack occurs once or several times within a few seconds. It is more common before going to bed or just after waking up, or it may even be a persistent state. Myoclonic seizures often occur after one twitch, followed by several consecutive twitches after a few seconds. It is most likely to occur when a person is about to fall asleep or about to wake up. Therefore, it is sometimes misdiagnosed as hysteria.

Drug treatment

① Hormone: (ACTH) 25μ～40μ per day, intramuscular injection for half a month, then change to prednisone 2mg/kg per day. After taking it for 4 weeks, the spasms stop. The dose can be reduced by 2.5mg per week until it reaches 1/2 of the initial dose, and then maintained with a smaller dose. When a hormone is ineffective at high doses, other preparations should be used instead.

② Valproic acid has certain therapeutic effects, rapid effects, and few side effects, but the dosage is large.

③Vigabatrin is a new broad-spectrum anti-epileptic drug and a selective transaminase inhibitor. It can easily penetrate the blood-brain barrier and increase the concentration of GABA (inhibitory neurotransmitter) in the whole brain. It has low toxicity and is a non-protein compound that does not induce liver metabolism. It is excreted in the urine in its original form. According to the records of the 1991 World Epilepsy Conference, this drug treatment is a new era in the treatment of epilepsy. According to controlled treatment reports, seizures are reduced by 50% in approximately 50% of cases, and partial seizures are better than generalized seizures, with no reduction in efficacy with long-term treatment.

Ehironc treated 70 infants and young children with refractory infantile spasms, including 47 infants, with Vigabatrin in addition to conventional anti-epileptic treatment. All patients had poor response to previous medications (including corticosteroids, imipramine, benzodiazepines, and sodium valproate). Two patients withdrew before efficacy evaluation due to intolerance to Vigabatrin (hypotension or hypertension). Of the remaining 68 patients, 29 (41%) had complete control of spasticity and 46 (more than 50%) had reduced spasticity, with the best effect in tuberous sclerosis. 52 of the 70 patients had no toxic side effects after taking the drug. Common side effects at the beginning of treatment were drowsiness, hypotension, weight gain, excitement, and insomnia, which were usually short-lived.